Senior Citizen's Guide digital books
Senior Citizen's Guide to Indianapolis

The Emerging Home Health Care Option

Over the past decade, home health care has become a viable alternative for many older Americans. Several important factors account for this, not the least of which is recognition that most seniors simply prefer to remain in the relative comfort of their own homes. Who wouldn’t? The reasons are obvious. For most individuals, home care is much less expensive than institutional care and combined with the ability to maintain independence, dignity and emotional well-being, it is easy to see why this is a popular choice. Changes to the bureaucracy of health care funding and technological advancements in medical and personal care have also been pivotal to the emergence of home health care. As baby boomers age and the older adult population grows, demand for this service and the payment systems relied upon will continue to grow as well. And, as public policy continues to reflect this demand, informed decision-making will be critical to the average consumer’s ability to determine whether it is the right option.

Many public policy changes have sparked the rise in home health care. Two such developments are particularly noteworthy. The first is a 1999 U.S. Supreme Court decision (Olmstead v. L.C.) directing states to facilitate creation of medical and personal care alternatives to institutional settings. The other, the Money Follows the Person Rebalancing Demonstration (MFP), provides financial flexibility for institutionalized individuals to continue receiving health care at home or in community-based settings. The original target for these changes was individuals with physical and developmental challenges, but the appeal quickly carried over to older adult care.

Coinciding with these health care law changes, developments in medical technology have also helped transform the idea of home care into a viable option. One significant development is the advent of electronic monitoring. ‘Telemedicine’ has now evolved from basic monitoring of vital signs to more advanced functions like diagnosing, retinal or radiologic imaging, and automated medication delivery systems. Refinements in the ability to monitor and care from afar enables more efficient utilization of health care resources and offers hope for more effective patient care.

Home health care describes an array of services traditionally carried out in an institutional setting that are made available in the comfort of one’s own home. Services include medical and nursing, therapy, social work and counseling, dietary assistance and personal services like homemaker assistance, help with activities of daily living and basic companionship. Providers can be Medicare-certified or independent medical and personal care agencies as well as those specializing in pharmaceutical and medical supplies and equipment.

Health care discussions inevitably veer toward the public and private payment systems traditionally relied upon to fund health services. While, some people are financially able to pay for health care on their own, most rely on either private (Medicare supplement plans, long-term care insurance, managed care coverage, military dependent and retiree coverage or workers’ compensation) or public (Medicare, Medicaid, the Veteran’s Administration or other federal) payment systems.

As health care costs soar and demographics shift to reflect more older adults, health care funding generally and home health care specifically will remain hot button issues. To put this in perspective, in 2009, the Centers for Medicare and Medicaid Services (CMMS) projected total U.S. health care spending in excess of $2 trillion with the home health segment accounting for over $70 billion. The enormity of spending ensures this issue will remain a focal point for public policy attention and as debate continues policymakers will increasingly target the Medicare and Medicaid public payment systems. Appropriately so. In 2009, Medicare accounted for 41% of total home health care expenditures. Older adults are often beneficiaries of home care, so it follows that Medicare would be a key financial driver for this service. Home health care is, in fact, a Medicare covered benefit.

Medicare’s role in funding home health care has more recently begun to give way to Medicaid. This trend shows up in the relative decline in Medicare total expenditures on home care from 1997 (9%) to 2008 (4.2%), in the decrease in home care clients served from 1997 (3.6 million) to 2008 (3.5 million) and the sharp reduction in home care visits per client from 1997 (73) to 2008 (35). Over the same period (1997-2008), total Medicaid spending on home care rose dramatically (from 9.8% to 23%) as did the number of Medicaid home care recipients (from 1.9 million to 6 million). This change is in part due to broader Medicaid participant criteria and a greater scope of personal services Medicaid can fund, but the shift in public payment systems is nonetheless significant.

The emergence of home-based health care can be attributed to technological advances, public policy changes and lower costs. But, the other driving force is an overwhelming preference people have to remain at home. This appeal relates to personal independence and dignity and to continued ease of access to family, friends and other social supports. Common sense and research both suggest that the home care option helps sustain an individual’s psychosocial wellbeing. Growing evidence also supports not only the relative cost effectiveness of home care, but better recovery experiences for those who choose this option.

Ultimately, the decision to choose home health care is a very personal one. It represents an encouraging alternative, but not a panacea applicable to everyone’s situation. Whether it is appropriate depends on the level of skilled care an individual requires. So, despite key developments greatly facilitating its viability, home care may not be the best fit for those facing complex ailments and comparatively intense medical needs. When it does prove to be a favorable option, however, consumers should be poised to make well-informed decisions regarding the overall level of care and scope of services required as well as the organizations available to offer those services. Consumers can arm themselves with sufficient knowledge and familiarity to make informed decisions about whether home care is appropriate and when it is they can convey their intention and ability to actively engage in their plan of care.

Home    Featured Programs    Choose Local Area     Request Information
A JR Media Publication • www.jrmediallc.comSite Index